Provider Demographics
NPI:1033244082
Name:BURDEN, RANDY WAYNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:WAYNE
Last Name:BURDEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MANGHAM CT
Mailing Address - Street 2:
Mailing Address - City:PERALTA
Mailing Address - State:NM
Mailing Address - Zip Code:87042-8847
Mailing Address - Country:US
Mailing Address - Phone:505-565-3377
Mailing Address - Fax:
Practice Address - Street 1:609 CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-2615
Practice Address - Country:US
Practice Address - Phone:505-864-5454
Practice Address - Fax:505-864-5450
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM000062321835P1200X
NMPC 501835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy